Provider Demographics
NPI:1427121987
Name:CARPENTER, CHAD A (DC)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:A
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:830-816-4357
Mailing Address - Fax:830-331-8718
Practice Address - Street 1:1510 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-816-4357
Practice Address - Fax:830-331-8718
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 8280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8305OtherMEDICARE PTAN
TX8B7780OtherMEDICARE PTAN
TXU82057Medicare UPIN
TX502184ZG9WMedicare PIN